175657 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M& AMOUNT: $540.00
CARMEL, INDIANA 46032
P O BOX 19383
off `o INDIANAPOLIS IN 46219 CHECK NUMBER: 175657
CHECK DATE: 8/6/2009
DEPARTMENT A CCOUNT PO N I NUM A DESCRIPTION
1046 4340700 242104 540.00 MEDICAL FEES
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Community Occupatik�.
P.O. Box•
Indianapolis,
TeS4!?)l 7-355-,,, n T
PA+.A P „P Tax ID 35
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Invoice 4�
July 02, 200,
l ill to: Lynn Russell o !cs &Recreation
Carmel Clay Parks Recreation v o a
1411 E. 116th St.
Carmel, IN 46032
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Invoice 242104
1f Code Service Date Description Qu. t Rd;ust Balance
"'A'.01 06/18/2009 Drug Screen Non NIDA 5 Panel i 45.00
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sue: 45.00
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06/30/2009 Drug Screen Non NIDA 5 Panel 11 d 45.00
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4 45.00
21 N
X101 06/09/2009 Drug Screen Non NIDA 5 Panel 1.0'. 45.00
Heath`, 45.00
1 o
06/09/2009 Dru g Screen Non NIDA 5 Panel 1.00 45.00
Rohan 45.00
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0101 06/15/2009 Drug Screen Non NIDA 5 Panel 1.00 n 45.00
Clark a 45.00
_O1 06/03/2009 Drug Screen -Non NIDA 5 Panel 1.00 45.00
Amy M`, 45.00
a
101 06/09/2009 Dru g Screen Non NIDA 5 Panel 1.00 45.00
Abigail K Krani 45.00
;.'.0101 06/02/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Julia L Newten Balance Due: 45.00
e!) 101 06/09/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Dustin S O'Bold Balance Due: 45.00
ti 1101 06/11/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
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li-o Invoice 242104 (continued) page 2
o i Dior B Sharp Balance Due: 45.00
i 0101 06_/02/ Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amy Wesner Balance Due: 45.00
80101 06/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Nathaniel T Woeste Balance Due: 45.00
Invoice 242104 Balance Due: 540.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
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Cut and return with payment
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
355031 Community Occupational Health Services Terms
P.O. Box 19383
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7/2/09 242104 Pre employment drug testing 540.00
Total 540.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5 11 -10 1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
540.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. 4CCT #/TITLE AMOUNT Board Members
Dept
1046 242104 4340700 540.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
30 -Jul 2009
Signature
540.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund